A surprising number of dental patients on the wiki have left comments questioning billing procedures and diagnoses of their dentists. These comments are especially hard to sort out for a few reasons. For one, nobody likes going to the dentist, so it's easy to come away with negative feelings. As well, many college students may be handling their dental insurance for the first time and may be unaware of how it works. Nonetheless, if any sort of fraud is occurring, it benefits everyone (everyone with teeth, and everyone who pays insurance premiums) to root it out.
Questionable practices mentioned by patients:
- Charges exceeding the amount the dentist submitted to the insurance company. This is a violation of the contract between an insurance company and the dental office. Most insurances expect the patient to pay a portion of the fee (co pay). Just because a dentist accepts a certain insurance does not necessarily mean they are contracted with that insurance company. If a dentist accepts an insurance, but is not contracted with them, then the dentist will submit their usual and customary fee (which can be higher than a contracted fee) to the insurance company. The insurance then pays the dentist whatever is dictated by the patent's plan and the patient is responsible to pay the difference.
- Diagnoses of cavities when none exist. (E.g. "you have eleven cavities"). This is particularly tricky because once a hole has been drilled, the evidence is gone. Also some dentists have different opinions of what needs a filling. Some dentists prefer to watch very small cavities (in hopes that they don't spread) and some dentists like to restore very small cavities.
- Charging for multiple cleanings or only cleaning half of a patients mouth. Sometimes the dentist or hygienist needs more than one hour to remove all the tartar from your teeth. Most insurances only cover 1 cleaning every 6 months and the patient has to pay out of pocket for the second cleaning. This is very frustrating to the patient if it is not explained, however, it does not constitute fraud.
- Not releasing records or x-rays to the patient. It is customary for dental offices to charge a nominal fee (usually about $30) for the duplication of x-rays. Dentists are required to release these records upon written request of the patient, they are not required to do so for free.
How to avoid dental fraud:
- Know what your insurance does and does not cover. (You are responsible for knowing what your insurance covers, not your dentist.)
- Get in touch with your insurance before paying any bill that you think is questionable. (Calling them afterwards is okay too.)
- Get a second opinion if you are suspicious of a diagnosis (most dental plans cover second opinions).
Note on ethics of accusations
While we all want to stop dental fraud, it is important to keep in mind that any unfounded accusations can be very damaging to a potentially upstanding practitioner. For this reason, it is important to be absolutely certain a practice is fraudulent or unethical before leveling accusations.
UC Davis students are covered by Delta Dental. See their page on Dental Insurance Fraud (http://www.deltadentalca.org/enrollee/fraud.html). But keep in mind that this page discusses more than just insurance fraud.
2006-06-13 09:52:26 A common thing I've heard and been told about has to do with overcharging insurance, but not at the expense of the patient. I know for sure that wisdom teeth are a big issue as they have to be surgically removed. It costs a lot more to remove an impacted wisdom tooth than non-impacted ones. Most all insured people will pay the same amount no matter what (since it's so costly either way), but one of the most common practices is insurance being billed for 4 impacted wisdom teeth (if in reality it was only 2 or 3). As the patient pays a set amount either way, most people either don't notice, or don't care as insurance will cover it. (People might not care as a normal dentist can't perform this procedure, and you'll need to see a oral surgeon for this one time event). —ES
2007-04-15 09:35:52 Definitely get a second opinion if you're not sure about the diagnosis, but here's another thing to keep in mind — dentists differ in their treatment philosophy. Some want everything to be perfect, so if they see a tiny little problem, they will fix it. This sort of dentist will be the one who tells you that you need lots of fillings, etc. Other doctors are more willing to take a "wait and see" approach; sometimes small cavities or other problems don't amount to anything, or won't amount to anything for a long, long, time. Personally, I'd rather have the "wait and see" dentist than the "perfectionist" dentist, but the thing to do is to match the kind of dentist you want with the kind of dentist you have. This is the sort of thing you might ask about in your first visit with a new dentist: ask, "what is your treatment philosophy?" I had a perfectionist dentist once, and I will always wonder if I really needed the treatment that I received. —CovertProfessor
2008-02-06 11:09:40 When decay is shallow and in the enamel only it is reversable. Ions from your saliva can absorb into an early lesion and remineralize the affected enamel. This generally only works on the smooth surfaces of the teeth (like in between the teeth and on the sides). When decay is very shallow on the chewing surfaces of the teeth it often continues to spread despite all best efforts to keep the areas clean. This is because all the pits and grooves of the teeth harbor many bacteria and are difficult if not impossible to clean. Access to decay in the pits and grooves of the teeth is often straight forward; therefore, removal of only the decay with a very small preparation (hole)can be achieved. This is often referred to as "microdentistry". So if your dentist tells you you have cavities ask if any of them are possible to remineralize. Remineralization can be assisted by fluoride mouthrinses and xylitol chewing gum. Xylitol is a natural sweetener that inhibits bacteria from sticking to the teeth. The most important aspect of remineralization is preventing acid attack, so brush and floss daily (flossing is ussually the key) and avoid frequent sugar/charbohydrate snacks. Once decay has grown past the enamel and is into the dentin (the inner part of the tooth) a filling is necessary. If you are attepmting to remineralize some very suspicous areas of decay your dentist may want to take x-rays more frequently to make sure they dont spread too deep. If anyone has questions about dentistry, dental materials, or preventive dentistry please go to dental questions I will answer any questions people may have. - Dagon H.C. Jones DDS
2008-05-20 20:43:48 On top of what Dr. Dagon Jones has said, you can get Xylitol at Kim's Mart with the brand by Lotte or you can head over to the store next door, I think it's Davis Health Foods? The name escapes me now, but you can get Spry gum with Xylitol right there! —CalvinCheng
2010-01-29 22:49:36 My husband took my 5 yr old in for 2 fillings in her baby teeth (Tooth#A-O and J-O). He didn't see a drill or a shot just a "nail polish like brush" the dentist used on her teeth. Sounds like sealants, but I was charged $152 for each cavity. Her appt was at 0800 and he was done and checking out and leaving with her at 0823 am. I have changed offices and pursued this, but seems like the new dentist is covering for her because he didn't acknowledge that there were restorations there, but when I filed a grievance with Delta Dental, he sent a letter stating he looked at her teeth and the restorations are there. I spoke with that office concerning this issue over the course of two weeks and not once did he tell me that they were there. When I questioned the original dentist and told her my husband was there the whole time and didn't see a shot or drill, she told me that maybe she did it so fast that he didn't see it. Suspicious? She has also sent documentation that she gave her lidocaine, but my husband saw none of it. In fact, he was waiting for her to get the shot because he knew she would freak out. Also discoverd that my 8 yr old had sealants put on tooth 19 and 30 and at the next visit with the new dentist, he said it looked like nothing was ever there.—MMG
2010-02-09 10:43:37 This last comment is a tricky one to evaluate. I cant say what happened one way or the other but it is important to understand that a filling can be done without a shot. Anesthetic is not always necessary when doing a small filling. A drill or similar instrument is needed to remove the decay (otherwise it is considered a sealant, not a filling). Instruments other than a drill can be used such as a microblaster (like a small sandblaster) or a laser, both of these are uncommon and not frequently used on kids. Also many filling materials and sealants are tooth colored so it can be very hard to notice them on the teeth once they are done. —DagonJones
2010-02-11 20:45:17 I guess my main point was that I point blank asked the dentist if she gave her a shot with a needle and she said yes. My husband did not see this nor did he see or hear any type of drilling. This is where I believe she is lying. I feel she isn't being honest with me given the circumstances that my husband witnessed and the use of the sealant brush. My husband also works with someone whose friend left that office after she was told to bill for services not rendered. She refused so she quit. When my husband returned to work that day, he expressed how surprised he was that he was in and out of there. He also mentioned that filling cavities had changed a lot since he had them because there was no drilling or shot. This is what raised my suspicions that it wasn't cavities that were filled, but sealants done. My complaint has more to do with the ethics since I spoke to the dentist myself and to tell me she did use a needle and did it so fast that he maybe didn't see it just doesn't seem reasonable. They sent me the notes after I requested them (I received them a week later) and it says right on there that she received a shot and that a moderate sized preparation was done. From what I've read on the composite fillings, they seem to take a little longer to do so she is awful speedy if she got that all done for two cavities in 15-18 minutes, especially on a child who has never had dental work done. I did submit a grievance to the dental board in my state. I am hoping they will investigate and help me settle this once and for all. It's hard to let go of it if they are committing fraud because I obviously would not be the only one that has had this happen at that office. Thank you for your comments. —MMG
Your concerns are valid and I understand your suspicion. The situation you are describing sounds fishy. It is terrible to feel taken advantage of, especially when it involves your children. I hope you eventually get some answers that make sense.dagonjones
2012-03-24 19:48:08 we have a local dentist that has commited fraud in the past. he is the son of e very prominent dentist in the next town over. he completely destroyed his dads practice and had to leave town. now we are having a problem with him. if you aren't aware, there is a place for people who have no dental plan and need dental work, there is a place called care credit. it is just like a credit card company, but it is only used for dental work. my little niece, who was only 23 at the time went to this dentist and had x-rays which were paid for in cash by my elderly mom. he said the work that needed to be done would cost $5,500.00, so they applied for the credit. on the next visit my niece had 5 teeth pulled and a filling, which soon fell out and that is ALL the work she ever had done! then she found out she had cancer and died at age 24 and never returned to the dentist. this so called dentist charge the whole $5,500 on her second visit for work he had never done!!! she is dead and they are after my mom to pay the $5,500.00. while she had been getting billed she was paying $250.00 a month to the care credit, so she has already overpaid them. this dentist has been in trouble for fraud before. i got all the bills together and took them to the county attorney and he looked them over and he even agreed with me, he said the dentist is even charging us interest on something that has already been paid for, which he said was illegal. he also said that a dentist can't do $5,500.00 worth of work in one day! be he won't touch it with a ten foot pole! he told me that the dentist's kids and his kids went to school together and it was a conflict of interest!!!!!!!!!! the county prosecutor won't touch it! i can't find anyone who will take on this case!!!! in the meanwhile the credit company is threatening all kinds of legal, action against my 86 year old mom and we cqan't get anyone to help us????? i guess it is the truth, that lawyers and doctors all stick together and my family is just screwed! we have already overpaid this dentist for the work he has done which wouldn't even total $500.00 much less $5,500.00 what are we supposed to do???? who can we turn to for help??? —bobbyshahan
- Try the Dental Board of California: http://www.dbc.ca.gov/consumers/enforcement.shtml
2013-01-17 12:30:53 I find most health care providers will give X-ray copies for free or a nominal ($5-$15) fee. These always are professional copies of the XRay and/or CD of the imaging. My dentist wanted to charge me 30$ for a printer paper copy of my dental x-rays. Not on a CD or professionally printed, but on regular printer paper. When I inquired then about the large fee, the assistant told me that fee was not for materials, but only to release my records which are owned by the dentist. I felt that was poor business practice.
Also, I went in for an examination and x-ray, and the dentist cleaned my teeth, did not examine then, and took an x-ray. Then I was told I could leave. When I asked about my x-ray the assistant told me the doctor would call me to let me know if I had cavities or not. Huh? The entire scenario was so strange and unprofessional. I opted to stay and within 3 minutes the assistant returned and informed me the dentist said I had no cavities. Just like that. No showing me the x-rays or explaining anything, just, no cavities, when would you like your next appt?
I don't think I will be making any further appointments.
Also, I have several brown spots on my teeth and one specifically concerning one that seems to be some kind of deterioration. The dentist said it was left over adhesive from my braces which had turned brown. However, it is not in the right place and does not seem to be adhesive, it looks and feels like a decaying area. Every time I voice concerns about the brown spots, the dentist says they are just discolorations. I have not had any cavities according to my dentist for 3 years. That seems unusual considering I had braces for 18 months and my teeth care was not optimal during that time.
Any advice on these strange occurrences??
- Here is information about the California law regarding patient access to medical records: http://www.mbc.ca.gov/consumer/access_records.html (see also http://www.mbc.ca.gov/consumer/complaint_info_questions_records.html)
The patient or patient's representative is entitled to copies of all or any portion of his or her records that he or she has a right to inspect, upon written request to the physician. The physician may charge a fee to defray the cost of copying, not to exceed 25 cents per page or 50 cents per page for records that are copied from microfilm, along with reasonable clerical costs. By law, a patient's records are defined as records relating to the health history, diagnosis, or condition of a patient, or relating to treatment provided or proposed to be provided to the patient. Physicians must provide patients with copies within 15 days of receipt of the request.
Copies of x-rays or tracings from electrocardiography, electroencephalography, or electromyography do not have to be provided to the patient or patient's representative if the originals are transmitted to another health care provider upon written request of the patient and within 15 days of receipt of the request. A patient may request to purchase copies of his or her x-rays or tracings. All reasonable costs, not exceeding actual costs, may be charged to the patient or patient's representative.
I'm not a lawyer, but it sounds to me as though your dentist should not be charging you $30 for printer paper copies of your x-rays. As for your brown spots, I can't imagine why a dentist would not want to fill a cavity, but if you have concerns, I don't see any alternative but to see another dentist. —CovertProfessor
2014-01-22 23:16:27 My dentist charged me for "immediate dentures", I didn't get the uppers for a month and the lower partial 2 weeks later, also he left a piece of tooth then charged another $500 to remove that, also the upper was crooked, when I told them they mickey moused it straight by making the right side 1/4 inch thicker than the left, and even my regular doctor asked why my upper lip is sticking out so far, so I showed him. Its ridiculous that they still haven't got it right, (7 months have gone by), and I am paying these clowns a small fortune for shawdy work. do I have gto keep paying these guys even though I am going to have to pay a competent dental office to do things right ? Do I have any recource ? Any help wou;ld be greatly appreciated. Glenn Rose, email@example.com —GlennRose
2015-02-06 04:50:26 I trusted my dentist i know that was were i went wrong but i feel i still need to express what happen i paid it . id like to say a few not so nice words here about him but won't . here goes i will try to keep it as short and to the point as i can . on july 2013 i asked my dentist if a some thing was covered he told yes it was a month later and i trusted him then my Mom became sick so i had to put it off till the following year so in july 2014 I had it done was told then three times each time i asked was it covered and was told yes all three times , i should have known then it was not but as some do i blindly trusted him and his billing who also told me to it was which is hear say i know sense it's not in writing .it was done in trust so on Nov 2014 i get a bill for 403 $ on top of my so called co pay of 333 $ i had to pay when it was done btw the co pay i paid for was not for that treatment that copay was for treatment that was approved in 2011 for a completely diff treatment that can prove but because i did not get it in writing or actually check with insurance company that was my fault because of trust fro this treatment sigh. my whole point to the whole mess is i paid it because of trust i was lied to the dentist used what like to call legal extortion . he lied to me with the intention to collect more then what the right treatment would have paid him . all because of trust and I did not check to make sure . what i should have done at some point in the whole mess was ask for it in writing then after i got it in writing reported him for fraud . sadly that's how blind trust is some people know how to use the law to preform illegal acts and get a way with it . all in all i don't see him any more but now he won't give me my records so now i know i have legal action i can being against him if he keeps refusing to release them to the new dentist who seems to be just as bad as he was but this does stuf that is approved just over bills which im watching I may be looking for another dentist yet . this will be my fourth dentist it seems they can do what ever please them then charge you for it . i even had one who got caught not paying his Employee tax for a few years i knew he was up to no good when he stopped doing anything but high dollar treatments and his help was starting to jump ship so to speak. it's best to make sure don't trust them no matter how much they seem to care that may just be a front to walk all over you . —toptek
2015-11-24 23:40:24 I broke a tooth that had weakened under old amalgam fillings and chose a family member's dentist who came highly recommended - He took two x-rays, not full mouth and determined that the broken tooth needed a crown, he also want to replace other amalgam fillings with composite. He said that this would require two appointments, the first to prep the tooth to be crowned and replace a couple of fillings - no problem. He and his EFDA did not explain details and seemed bothered that I asked questions. This guy likes to dope up his patients to make them docile, performs partial services then over bills for his work: Because I was tender and had a bit of dental anxiety, I requested Nitrous Oxide, instead he prescribed Triazolam .25mg - One pill to be taken the night before the procedure and two, one hour before. I followed his instructions and arranged for a ride to and from the office. I had a fairly severe reaction to the Triazolam - Dysesthesia that presented as amplified mouth pain - the Novocain injections were horrific as he was brutal, in addition, because Triazolam is a muscle relaxer and sedative I had no muscle control over my epiglottis and kept choking throughout the procedure as I was breathing in the spray and he seemed irritated that I kept interrupting the process. Before the EFDA led me to the lobby I asked if there were any instructions: She said, "Don't chew on that side and don't eat anything hard." I then checked with the receptionist who scheduled my return appointment for 7 days later. This was my first crown so I did not know that there was supposed to be a temporary cap or replica of a tooth sitting where my broken molar had been: THERE WAS NO TEMPORARY CAP. There was a depression where my tooth had been and the dentist had swabbed on some temporary dental cement. I discovered this as I had increasing discomfort that graduated to real pain every time I brushed my teeth and swished with mouthwash. Again, I thought this might be normal from the procedure I'd just had and didn't want to jump to conclusions. I did not know that I was brushing off the only thing between a raw nerve and the outside world. I felt weak and fuzzy headed for a couple of days after the first appointment, had terrible nightmares about drowning and awoke in tears and had intense anxiety - I later learned that these are side effects of the drug. So, I drove down the dental office to report that I'd had very adverse reaction to the Triazolam and requested Nitrous Oxide for my next appointment - I willingly agreed to pay out of pocket for the Nitrous and said that I did not want to take Triazolam again.. By the next day, I had brushed off the last of the dental cement as I was having spiking pain that radiated down my jaw so I tried to quell it with Anbesol - worst mistake ever! The raw nerve was screaming pain and brushing my teeth made me weep. By the next afternoon my husband became worried and called the dentist for an emergency appointment for me - they refused without explanation. Instead, the dentist wrote a prescription for Norco 5/325mg that he wanted me to take until the day my crown was to be seated and cemented. He also told my husband that he wanted me to take the Triazolam one hour before the next appointment. When my husband objected because he knew how intensely it had affected me he was told - "Oh that's a common reaction." At this point I'd had enough. I found a no pain dentist who could see me right away. He asked if he could contact the other dentist to get a look at the x-rays and I gave consent. He explained all of my options and created a temporary cap for me. He told me that the other dentist offered to let him have the permanent crown as it was sitting in their office but I would have to pay them $200 cash, for "lab services." Initially I agreed to go retrieve my crown but thought I should talk with my insurance provider first - the person I spoke with was shocked. "Lab services" are included for all restoration procedures. My insurance provider advised me to stay away from the 1st dentist and file a complaint. It was also explained to me that the dentist who creates the temporary cap should be the same one who seats and cements the permanent crown as all of the process is covered. I opted to follow the advice of my insurance rep.; cancelled my appointments with the first dentist and am established as a patient with the second. I just received a copy of the billing report from the first dentist - $1100 for 3 fillings (replacements $300 each) and including $264 for non-extant buildup and pins. He is under investigation by the insurance co as well as the state board. I'm wondering if his cavalier use of strong sedatives, partial service and over billing is a disciplinary issue - I'm certain that I am not the only patient who has been treated to his special brand of barbarism. I'm lucky I got out of there with both kidneys - I'm thinking he's got a bathtub full of ice in the backroom for patients who weren't 'compliant' (kidding). Can he charge me for the permanent crown that he never seated and that I do not have? —Painless